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Autism and ABA (behavioral intervention)


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The title is a bit misleading - most of the questions I get are some variation on How can I get services for my child?


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My child has PDD/Asperger's/Hyperlexia, not autism. Does he really need all this ABA stuff?

The different labels used to describe the pervasive developmental disorders (PDDs) have little use other than to confuse parents and muddy their children's legal rights. There are occasionally reasons why a qualified diagnostician may use one term rather than another, but for the most part the label really doesn't matter. What counts is effective treatment.

The term "autistic spectrum disorder," while not 'official,' does make the situation clearer. Individuals with PDDs vary widely in their degree of disability. The greatest mistake you can make is to believe (or not challenge the opinion) that because your child "just" has PDD then he or she does not need a high-quality, intensive program to help him or her "catch up" as quickly as possible. It is true that more severely disabled children will typically require more hours than those on the less severe end of the autism spectrum, but that is a judgement to be made by a qualified professional. The range is likely to be from 10 to 40 hours/week.

My son, for example, fits the published criteria for "the syndrome of hyperlexia." This really means that while he has autism he also has above average ability (and motivation) to work with letters and numbers. But if we had stuck with the available literature on "hyperlexia" we would never have found the intensive ABA approach that has helped him so much.

What is an ABA program?

(See also What is ABA?) There are three components that all have to work together: people, programming, and practice. And they have to work together for quite a while - at least two years, usually longer.

The people are a behavior analyst, 'therapists,' you and other significant family members, and usually (although perhaps not at first) your school staff. The behavior analyst (usually just called the 'consultant') is responsible for the other components, programming and practice. He will help train the therapists and you in the practice of ABA, and give you (your team) the curriculum ('programming') that tells you exactly what and how to teach. He will also periodically evaluate results and adjust the program as your child learns.

The therapists provide the actual instruction (usually one-on-one, but not always). Why the quotes above? The term therapist has a medical or professional implication: it implies training and certification in a specialty. Training and good practice are important in an ABA program, too, but there is no specific degree, coursework, or internship required. In theory, anyone can learn to become an effective ABA instructor--college students, retired persons, freelance musicians, even exceptional high school students. A degree or specialized education may be helpful, but what counts most are reliability, enthusiasm, creativity, ability to follow directions, and just plain "being good with kids."

Parents can be therapists, too, if they have the time and the inclination, but this is very much a personal decision. It can be a way to save money, keep the hours up, and it certainly gives you better knowledge of your child's program and progress.

School staff do not provide one-on-one service (except for specialists, who may or may not be working with the ABA program), but they are still very important--they are part of the environment in which your child will either learn or fail. This is a complex topic, but it's certainly true that cooperation is critical; if they "don't believe" in what you're doing, or think they're doing something better (but the evidence shows otherwise), then your child may not benefit from that environment.

The programming is, in my mind at least, the most distinguishing feature of an ABA program. Bits and pieces of the practice show up in other "methods" or therapeutic approaches, but to my knowledge there is no other program which puts so much care and thought into planning exactly what your child should be learning, how the material is paced, how it is reviewed, and how it is practiced across multiple settings. It is this tremendous discipline and attention to detail that makes it possible for some children to become truly indistinguishable from their peers in 'just' a few years.

Programming centers on discrete trial drills, the exercises that your child does one-on-one with a therapist to learn language, play, and social skills. These drills are completely individualized to your child; while there is a substantial core curriculum that all children must complete, which programs are introduced when, and what items are used for teaching, are carefully tailored to your child's abilities and interests.

The pace of the drills is important too. It is quite possible to go too quickly, leading to superficial progress but not a solid, useful repertoire of skills. A good consultant will plan how often new items are acquired (taught), how often know (mastered) items are reviewed (maintained), and when it might be time even to hold off on new items and just spend a couple of weeks practicing mastered items.

Skills must be mastered across multiple settings (home, school) and with multiple people (therapists, parents, peers). This 'generalization' is done systematically with the goal of giving your child skills that he can use independently in any setting.

Finally, it is practice, how skills are taught, that at first seems the most unusual feature of ABA. This is because the discrete trial format looks so very different from 'natural' teaching methods. But DT teaching is really only one result of applying ABA--the functional analysis of behavior--to the problem of helping your learning disabled child to progress to his maximum potential. A lot happens in those one-on-one sessions, but there are things that you and others can do at other times and in other settings to help your child learn. Again, a consultant will help you learn how to reinforce appropriate behaviors, to help your child, as he learns new skills, to discriminate desirable behaviors from undesirable "autistic" traits. In simpler terms, this is called "catch 'em being good."

ABA practice applies equally well to the school environment, even though your child will not be doing "drills" there in the strict DT sense. This is where a trained aide, who is part of the home program, is an essential part of the program. This is also the part that often confuses parents and distresses schools--unfortunate, because if done right, the benefits to all are tremendous (a good aide makes the teacher's job much easier). One of the most common mistakes parents and schools make is to place a child in school without coordinated support from an ABA trained aide, on the theory that "he needs to be around kids to learn social skills." Again, if your child could learn like that he wouldn't have autism.

If we put it all together--people, programming, and practice--this is what you have*:

  • A home program of 10 to 40 (or more) hours/week, with one-one-one DT drills delivered by 2 to 5 therapists or parents;
  • Workshops with a consultant, every 2 to 12 weeks, for 2 hours to 2 days, for an average of about 1 to 2 hours/week;
  • Weekly team meetings are desirable for all therapists to compare notes and discuss problems, get parental and teacher input;
  • For many children, a school placement of just a few hours up to full time, with an aide who is also a therapist;
  • Perhaps also play dates supervised by a therapist, usually structured sessions with one other peer;
  • You, personnel manager, accounting department, receptionist, special education teacher, supplies manager, ... and parent.

* This is a home-based program; there are also center-based (school) programs, which do most or all of the above at a single facility.

What kind of progress can I expect?

The amount of progress your child will make depends on two things: his innate ability to learn, and the quality of his instructional program. How much a child can learn given the best possible program is something no one can really predict, although there are indications from research that a higher developmental age (Lovaas 1987) and a younger chronological age (Fenske 1985) at intake are predictors of greater eventual progress. More recent experience suggests that the child's progress in the first few months--a measure of his ability to learn--is related to long-term success, rather than his initial degree of disability. Above all, understand that this is a very poorly understood subject: there really are no reliable markers in a young child that predict what he will be like as an adult. (Note too that some children benefit from other interventions, such as diet or drugs, that increase their ability to learn.)

Program quality is something you can influence. The number of hours per week is one obvious measure: since your child has a lengthy curriculum to get through, it is to his benefit to do it as quickly as possible. (This is one thing that many school administrators really do not understand; they believe that they can save money by doing fewer hours of programming each week, or fewer weeks each year. Yet the research suggests exactly the opposite: an intensive program is likely to be over sooner, while a lower intensity program may go on for years and years, costing much more in the long run.) Not only do more hours mean more learning, but if your child is not yet able to initiate appropriate activity, every hour spent learning is one fewer hour spent practicing undesirable activities. In the battle for your child's future, every hour falls on one side of the ledger or the other; you want to tip the balance towards productive, quality time.

Instructional quality is just as important. As one administrator assured us, "Any idiot can do ABA." This is true, but to do it well and actually help children takes a lot of training, attention to detail, and plain hard work. Children with autism are not often the best customers for good intentions; simply sitting down and trying to teach on instinct may lead to a wide array of unwanted behaviors, but little useful learning. The principle of providing positive reinforcement seems simple, but it's rarely enough just to give a child a piece of candy every time he gives a right answer; there are many, many details and strategies which a good ABA teacher must master to really move your child through the curriculum as quickly as possible.

You can and should expect your child to learn to his maximum potential, even though there is no way to be sure exactly what that potential is. You should, however, expect that if your child is learning some skills but then fails to progress in other areas, that the program, not your child, may be at fault. Educators and parents alike are often too quick to blame the child for failing to learn. This is the great shame of the IDEA law, that any progress (or lack of it) may arbitrarily be considered "appropriate" for your child. The research proves that some children do recover completely, and most others can make very substantial progress. While no one can tell you if that is possible for your child, he does deserve the same quality of instruction and the same chance at a normal life as the many children who have recovered completely.

Expect also that progress is like the stock market - you really have to play it for the long term. Three steps forward and two back is more the rule than the exception. Daily or weekly plateaus, spurts, and regression can be emotionally exhausting, but a high quality program should lead to measurable progress from month to month.

Does behaviorally-based teaching provide all the answers for all children? Certainly not; many children have cognitive deficits that cannot be completely remedied by any amount of teaching and practice. While those children (and adults) may gain a great deal, they will still need help learning strategies to work around their limitations, as well as a good deal of understanding and accommodation from the rest of us!

I want my child to learn naturally, not behaviorally. ABA looks so unnatural.

ABA is a well-developed technology for maximizing learning. It guides the teacher in maximizing those elements of one-on-one instruction that lead to the most efficient and longest-lasting learning. While at first glance it may look very "unnatural" that's only because the student typically is so learning-disabled that certain elements which are present in all learning must be greatly exaggerated.

As an ABA program progresses, if it is successful (as it is about 90% of the time), the student's brain changes - he "learns how to learn" like his typically developing peers. The teaching process then starts to look more and more "natural."

The very saddest thing a parent or teacher can do to a child with autism is to hold on to the illusion that he can learn as his peers do, and place him in a typical environment (even with extra support), expecting him to "get it." Child development involves an astounding amount of learning in a remarkably short time. Children with autism are typically far behind their peers in a broad range of prerequisite skills, even as young as age 2. There is simply no way they will learn "naturally" if they are not prepared with the base skills they need to understand what is happening in the world around them.

For example, suppose your child is in school and the teacher is talking about caterpillars and butterflies. Typical children will learn this in one lesson and have a lasting interest in the subject that will help them enjoy the world and give them something they can share with you and their friends. But consider what they first have to know in order to learn this lesson:

  1. The categories of insects and food
  2. The idea of one thing changing into another
  3. The concepts of eating and sleeping
  4. The preposition "around" (as in "spins a cocoon around him")
  5. Sequencing (first he spins...then he opens...)
  6. Past vs. present

That's just a partial list. Children also need attending skills just to pay attention to the teacher in the first place. Expecting a child lacking the prerequisites to learn "naturally" would be as misguided as placing an infant in the same classroom.

So what about all the odd-looking repetition, the use of edible treats, the insistence on sitting at a table, and the other "unnatural" trappings of ABA? All these are the result of very careful research on learning, an amplification of the processes that all children use to learn and develop. The teaching process may seem a little more "natural" if you compare it to the way a parent instinctively teaches his or her infant to smile. At first an infant has no idea how to respond to his parent - he may make contact or look at something more interesting. But when the parent gets even a little response - BAM! - a big smile, hugs, lots and lots of attention to the little guy. This is done over and over again until in short order he learns to give Mom and Dad a big smile and lots of eye contact.

This is pure positive reinforcement - a way all of us learn. A child with autism needs this type of intensive attention - or even more intensive attention coupled with individualized reinforcers - to learn very simple concepts like "on" and "in." But the good news is that if this is done properly then the child often will learn how to learn faster and with fewer and fewer "unnatural" interventions. There is simply no shortcut, no "natural" alternative. Just as infants cannot go to Kindergarten, so cannot children with autism "just learn" at their chronological age level. They must be led through the proper language, play, and social developmental sequence, not moving ahead until they have mastered each step.

I can't see my child spending all his time doing drills. Doesn't he need to go to school and play too?

An ABA program is not just discrete trial drills ("table-top work"). While drills may make up the bulk of a program at the beginning, the same principles used to instill very basic skills apply just as well in all settings, including classrooms, at home, and in the community. Remember that for typical children learning is a full-time job--it just happens without you even noticing. (If it weren't, no child would be able to attend Kindergarten without going to pre-school.) For a child with a PDD it takes careful planning by responsible adults to take advantage of as many opportunities for learning as possible. This means coordination across all settings, school included. Parent training and involvement is an essential part of almost all successful programs--remember, even if your child is in a full-time program, you probably still spend 60 hours/week with him.

Yes, children with autism can and do go to school with typical children, but no, it is not a good idea to do that unless the child is ready to learn in that setting and the school is committed to working closely with the rest of the ABA program. For several reasons, it can be quite harmful to the child to pretend that it is OK to have "two programs" that don't share goals or techniques.

  • Children with developmental disorders are at risk of developing maladaptive behaviors: aggression, self-injury, self-stimulatory and perseverative habits. These unwanted behaviors often increase or decrease in direct response to the actions of parents, teachers, and other care-givers. It is essential that everyone be on the same page and respond to the child in a consistent manner designed to reduce maladaptive behaviors, and that progress (or lack of it) be periodically reviewed and adjustments made as needed. We suffered years of serious behavior problems because the adults in charge of our child were not skilled, did not teach us what to do, and when asked for an appropriate behavior management plan, they were not able to execute it.
  • Your child deserves to benefit from every possible opportunity to "catch up" to his peers. This means learning and practice, practice, practice. If he has the skills required to understand what is going on in school and to be involved in what's going on, great. If not, even though he may be quite happy, it's just not fair to put him in an environment where he's not capable of learning and not capable of participating. The school must be involved daily in your child's progress and structure the environment so he can generalize his skills. One way to do this well is to have one of the ABA therapists be a one-to-one aide in the classroom.

This was one of the hardest lessons for us to learn: our son was (and is) very happy to go to school, but he literally was learning nothing (positive), despite support from an OT and SLP in the classroom and supposedly trained teaching staff. The school administration fought tooth and nail to keep our "methods" out of his classroom, supposedly for his benefit (!). Only after we gave him the basic language, play, and attention skills to understand what was happening did he start to benefit at all from school.

The same applies to peer social interactions. There is perhaps nothing more painful for the parent of a child with autism than to watch your child "play" in a group of typical children. Teaching play skills is very much part of an ABA program, and like all other skills, it is done one baby step at a time so the child cannot fail. The development of play skills is just as important and deserves just as much attention as language development.

ABA is not "just" drills. If it were, no child would recover to normal functioning. Your child needs you, his teachers, service providers, and all the other significant people in his life to work together to maximize his chances for progress. If any one of those people is not willing to participate, they shouldn't be allowed to waste his time.

What about diet, vitamins, and other therapies? Isn't it more important to treat the underlying cause?

For some children there may be a way to correct whatever biological mechanism is causing the symptoms of autism. Even if that's true, however, your child may have already spent years unable to learn language, play, and social skills as fast as his typically developing peers. He will need a lot of help to learn those skills, and ideally should do so at an accelerated pace. Regardless of the efficacy of other interventions there's still a lot of teaching to do, and that's where an ABA program is most helpful.

I don't mean to say don't try other interventions because ABA is "the" right choice. Just consider that if you could wave a magic wand and eliminate the underlying cause of your child's disorder, chances are he would still need a lot of help to "catch up" to his peers.

This is a mild statement of the importance of ABA in recovery from autism. In fact, the research shows that for many children ABA alone leads to a total loss of symptoms - that is, full recovery. It seems to defy 'common sense' that any amount of education could overcome a biological disorder, but the evidence is clear that an intensive program does lead to profound, permanent changes in the way the brain operates.

I've heard ABA leads to rote, "robot-like" behavior

Have you ever learned a foreign language (let's pick French), or watched someone else learn English? When you're first learning, you do sound rote, forced, unnatural, and you also feel the strain of trying to come up with the right words and keep up with a conversation. With time and practice your speech both comes more easily and sounds more natural. When introduced to someone you struggle at first even to say "Je m'appelle -------" . Months later, it is hard to imagine that is was so difficult - but now you're having exactly the same trouble with conditionals: "Si vous... voudriez me telephoner, je...je...serais chez moi...ce soir." [Any grammatical error is my responsibility!]

Or, you may learn some 'rote' phrases on what to say in a typical situation, like eating in a restaurant. You like chicken sandwiches so you learn "Je veux le sandwich poulet avec viande blanche." To an observer, you look silly ordering the same thing every time - because that's all you know and are comfortable doing. But the desire to gain access to the full menu will spur you on to master the language until you sound natural ordering a full meal, and can chat with the staff too.

Let's look at a more relevant example. My three year-old learned to identify emotions using the "developmental approach" - that is, learning from observation and practice. She made very frequent errors - "You don't want to watch TV, you're embarrassed," or "I'm fishing - be very quiet, so I don't get concerned." Because she could speak spontaneously and without any time delay, these statements sound delightful, not "robot-y." Yet the truth is, she was doing exactly what my son is doing - practicing language, making mistakes, getting corrected, and learning.

It takes time and practice for anybody, at any age, with any degree or ability or disability, to attain fluency. It is absolutely amazing that a child with such a severe disability actually can achieve fluency at language, play, and social skills. The fact that these skills may look less than completely natural at first should tell you that the child needs more practice and more opportunities for learning, not that he should be denied a proven teaching method. "Children do not fail to learn, teachers fail to teach."

(Postscript: one of my son's instructional programs was to "Talk like a robot"--his peers know how to do this, but he hasn't learned it 'naturally'!)

Won't a mix of ABA and other good approaches work best for my child?

A good ABA program--and by good I mean the level of quality implemented by Lovaas and reviewed in his 1987 study--has the potential to help many children gain the skills needed to overcome their disorder. This runs the full spectrum of skills from verbal imitation to prepositions all the way up to persistence, creativity, playfulness, empathy, self esteem, and curiosity.

This does not mean that just because someone says "I do ABA" or an administrator tells you "We're doing ABA" that your child will learn as much as he needs to. It has to be done right. Parents of children with high-quality ABA programs seldom look for alternative educational approaches. But it would be willful blindness to pretend there aren't ABA programs that don't work well. In those cases parents naturally look to other methods to help their children learn.

In one sense, an ABA program always does incorporate "other" teaching methods. Since the whole point of the program is to teach your child to learn normally - that is, largely from observation and imitation - the intervention by definition must include carefully supported practice in normal educational and social settings. This happens towards the end of a program (although this "end period" may last years!), and is every bit as important as the highly technical discrete-trial teaching. Some parts of a successful ABA program may be identical to practices promoted in other methodologies. It is the use of teaching methods targeted specifically to your child's learning style - methods that may change as his learning style changes - that makes your child successful. Research shows that leaving "behavioral teaching" out of the mix may mean he doesn't have a chance to get off the starting line.

There is an important caution here, however. Behavioral intervention addresses many of the deficits of many kids. Research shows it addresses all of the deficits of some kids. But the glass that is half full is also half empty: the same data proves ABA does not address all of the needs of some children. And, there is no reliable way to predict how much behavioral intervention will do for your child. It is important to work with a consultant or educational team that is not only well qualified in ABA, but also understands and is familiar with interventions for learning disabilities.

Many are quick to offer opinions or to trust in someone's reputation, but it takes courage and discipline to look first for data. There simply are no studies that show any intervention with a success rate better than those published by Lovaas, Fenske, and others (in progress). ABA is not a 'philosophy' that maintains credibility by excluding other methods. It is a science that continually advances its practice to best serve your child. Don't be afraid to ask tough questions of anyone offering any intervention for your child, whether it's ABA or another 'brand.' You will be living with the results for many, many years.

Is ABA appropriate for older children?

There is a popular misconception that ABA is useful or appropriate only for young children (under age 5). This notion probably comes from the remarkable successes of the UCLA Young Autism Project, in which many young children achieved normal functioning. While it may be true that the greatest benefit results from starting very young, this is of no importance when you are considering your child's future: however old he may be, you need to be sure you are giving him the best possible future.

The teaching principles of ABA apply to all people at all ages. It is a science of human behavior. It guides us in how best to achieve goals of skill development or independence regardless of age or disability or ability. Within the limits of your child's potential, intervention based on ABA principles will help him learn as much as he is able. Even if full recovery (normal functioning) may not be an option due to the severity of his disability or, perhaps, his age, there is no teaching method shown to have the same ability to develop his full potential.

A real tragedy is being played out again and again: young children are denied ABA services for years; then the parents advocate for a program, and are told, "Sorry, we won't pay for that because your child is too old to benefit."

More on the topic by Dr. John McEachin

I'm afraid that having to place so many demands on my child will harm our relationship

It is very true that an ABA program places many, many demands on your child. And it is also true that for the program to be effective, you (the parent) have to place many of the same demands. If all his teachers make him ask for his own juice, but you don't like to see him struggle to find the right words and just jump in and offer juice before he asks for it, then he may not generalize that communication skill as quickly as he otherwise would.

This is a simple example; there are other things you may need to ask of your child that he will find much harder and to which he may react more strongly--by crying, yelling, hitting, running away. These are extremes of reaction, and they shouldn't happen often, but some level of problem behaviors is more the rule than the exception. It is hard as a parent not to give in and just do whatever seems necessary at the moment to make things easier for your child.

In the long run, however, it is probably easier for both of you to maintain the demands and make learning happen, than to adapt yourself to his (unconscious) desire not to change. This is not peculiar to children with autism; all parents learn that life goes better if they insist that their children clean up their toys, observe table manners, stay close in stores, even if it takes some amount of stress to enforce those rules.

Does this affect your loving, trusting relationship? The trust and love that you and your child feel for each other is built on thousands and thousands of positive, successful, joyful interactions. It would take a far greater effort to undo something so deep and powerful. Being firm when it is appropriate is the quickest path away from unwanted behaviors and situations, the best route to positive, happy experiences. You don't have a choice: you will have to place more demands on your child as he grows older. It is best for both of you if you can help him learn to be successful, independent, in control of himself and his environment, and able to find his own happiness from you and others.

What is the role of a school aide in an ABA program?

First, you have to be sure that school is an appropriate environment for your child. Just as you would not send an eight-year old to a college calculus course, so you would also not want a child with the communication and social skills of a toddler in a Kindergarten class. It is not only not an appropriate placement, it is cruel to the child; he is being set up to fail.

Once your child is ready to learn with other children in school, however, chances are he requires a level of attention that no teacher can be expected to provide. He may frequently lose attention, engage in disruptive behaviors, not respond to questions, not follow along with other children, or simply not understand instructions reliably. These are problems all children have to some degree, but which are effectively addressed by the classroom teacher. Children with autism may require such a high level of prompting or redirection that it is simply not possible for the teacher to do his job properly.

An aide, therefore, is there first to help the teacher teach, and to help your child second. He is an extension of the classroom teacher, giving additional attention to those who need it most (which, most of the time, will be your child). He will prompt your child as needed to keep his focus on the teacher or the other children, reward him as needed for doing a good job, cue the teacher if your child needs a reminder or additional instruction, and intervene to prevent maladaptive behaviors. He is an extra pair of hands and eyes and ears to help maintain order and progress in a classroom that has more than its share of children who need very clear instructions. He is there to give the extra attention needed to make sure that a certain special child is included in social activities, and has a friend who won't let him fail. His ultimate goal is to work himself out of a job; by intervening only as much as needed, he will help the classroom teacher integrate your child into the classroom and learn effectively alongside his peers.

Here is a nice first-hand account from news:bit.listserv.autism:

I have been a classroom aide many times over the past 5 years, both in preschool & grade school. From my experience, there are both benefits and disadvantages to having an aide in class with your child... The benefit is that a good aide can enhance the whole class experience, social and academic. The good aide will not draw "special" attention to your child, but be a friendly helper for all the kids. The good aide will make it a "fun" experience for other kids to socialize with your child, naturally and without inciting jealousy. The good aide will reinforce the teacher's direction, rather than becoming a "separate" teacher. The good aide will keep in touch with you (the parent) constantly, letting you know all the ups and downs, and will keep written daily notes of the child's progress. The good aide will work to work him or herself OUT of a job -- fostering independent work and social skills constantly.

The bad side is that unless you do have an extremely good aide, the presence and "help" of the aide will seem strange and unfair to your child's classmates, fostering envy and resentment. As the grades get higher, the more other children are wary of what is "different". In addition a poor aide will cause your child to become dependent, to ignore the real teacher and to indulge in behavior to get extra help. The poor aide will feel "sorry" for your child and not push him or her to do the best work that is possible. The poor aide will exclude you (the parent) from the educational process, will feel insulted and defensive when asked for specific information. The poor aide will not work with the classroom environment or with the teacher as a team member, and will set up "special rules" and exceptions that will cause your child to be a pariah.

So interview CAREFULLY; check references; watch the aide interact with your child and in the classroom before hiring; if possible, visit the classroom often in person to observe; never be afraid to train a person yourself; do not hesitate to give feedback to and even to remove a person who is not doing the kind of job you want. There ARE good aides (and potential aides) out there... keep looking. And good luck!

Are there risks? Could my child be hurt?

Keep in mind that the terms "ABA" and "behavior modification" are largely unregulated. With few exceptions, any professional can hang out his shingle and say "I'm doing ABA." The same is true in schools: an educational administrator who has attended a seminar or two can legally call herself an "Early Childhood Specialist," provide "ABA programming" for your child, but face no consequences if your child makes no progress.

When accountability is absent, the risk of malpractice is high. Untrained or inadequately trained people will, at best, waste your child's precious time - often at public expense. This would be intolerable in a medical setting, but the powers that be have decided that autism is not a medical problem. I have heard from many families who put enormous energy into getting a program for their child, only to face an even greater struggle to get quality programming and staff. At least you should check any service provider's qualifications and get references from other families.

The risk can be greater. Some professionals - even, in some cases, those with specialized training in behavior analysis - mistreat children (or adult clients). The organization Children Injured By Restraints and Aversives documents allegations of abusive practices, primarily in institutional settings (both public and private). Physical restraint may be needed to reduce the chances of injury, but as a "behavioral consequence" it is not a teaching method. (Note that abuse is possible under any conditions; there is no evidence that a person or institution claiming to practice ABA is any more or less likely to use inappropriate restraints or aversives.)

With appropriate caution, this shouldn't happen to your child. To the best of my knowledge, none of the resources listed in ABA Resources suggests the use of aversives or restraints. (The 20-year old "ME Book" has a chapter on punishment describing practices no longer taught or recommended.) Certainly all the people I have selected to work with my child have done so with a degree of patience and gentleness that any parent can only aspire to. (They're not better than you or I, they just get to go home at the end of the day!) In particular, if the bulk of the therapy is done in your home (the so-called "ABA home program") then you should know everything that goes on. If your child is in a school or institution, you should be permitted to visit at any time.

I read that the "Lovaas method" is less than 50% effective

This is a perfect example of damning with faint praise, almost always by those who would like to ignore the data and promote a different approach, or simply don't want to spend their money on your child.

Much has been made of the Lovaas 1987 published result showing 9 of 19 children (47%) achieved lasting normal functioning. This is an amazing, stupendous, wonderful result, but also an almost useless statistic - by itself. What really matters is that 90% of the children in the study made very significant progress - far more progress than the children in the control groups. It matters little whether 5 or 10 or 15 of them "went all the way" to total recovery. No other study has shown near the level of average progress, and no study shows any other intervention to be more effective at helping a child realize his maximum potential development - which is all anyone can ask for.

Here is a typical description by a well-known PhD:

The Lovaas method...uses behavioral techniques--molding and rewarding desired behavior, and ignoring or discouraging undesirable actions--to achieve its goals... Some research has shown remarkable progress in about 50% of the children receiving this therapy. The Lovaas Method is getting wide attention, but, as with other therapies, it needs more study.

This was in between summaries of "occupational therapy" and "vitamin therapy" in a long list of interventions for autism. Notice how "50% achieved normal functioning" turns into "50% showed remarkable progress," with no mention of the benefits to the rest of the children studied. In fact, more study is warranted, and is happening: there are "Lovaas replication" studies in progress, repeating the original experiment - including studies of improvements to the original protocol.

What happens after an ABA program?

Most children with autism require some support services throughout childhood, and often into adulthood as well. The best behavioral intervention program has at most an even chance of getting a child far enough along to participate fully in regular education. And, for too many reasons to list, few children get "the best," leaving most needing some extra services for many years. While the most severely disabled may benefit from a continued one-on-one behavioral intervention program, more will participate to some degree in a regular classroom with a mix of special education services. What should those services look like? How do you transition from a 'pure' ABA program to a special education setting?

The complete answers could fill several books.  There is a short answer, however. Behavior analysis can continue to play an important role even if none of the teaching follows the discrete trial format. (A not-so-secret secret: successful teachers of typical kids use behavioral principles all the time to run their classrooms, even if they don't consciously think they are doing it.)

The principles that help your child learn when he is three, four, or six years old are still valid when he is eight, eleven, fifteen. The format may be very different, but the underlying thinking is not. If he needed clear step-by-step visual instructions, chances are that is still true. If he was more able to follow a classroom routine with a reinforcement program, that will continue to be a useful tool, though the reward program may take a very different form. Just because something works well is no reason to stop doing it!

One principle you will want to keep for life is that each person is an individual, with specific strengths and weaknesses. People are most successful, and generally happiest, when they can apply their strengths and find ways to "patch" their weaknesses. A "one size fits all" education can't be perfect for anyone, and will probably be especially mismatched to your child. There are many good resources for overcoming learning disabilities and making the most of individual strengths.

Can I teach my child myself?

For better and worse we are all one of our children's most important teachers (perhaps "guidance counselor" is a better term). The question here really is "What role can I play in a challenging and technical special education program for a developmentally disabled child?" Notice a child, not your child. Ask yourself first: as a busy parent whose first responsibility is protecting and advocating for my disabled child, do I also have the time and energy to become trained in a new field and commit to being an effective teacher? If you can picture yourself doing that for someone else's child, then there's a good chance you could do it for your own. You may turn out to be an outstanding teacher! (In fact that's how some parents have started new careers - some I know have even founded new schools.)

If on the other hand you already have your hands full, your time or patience is stretched thin, it may be better to rely on outside staff to do the teaching. You may still want to attend the training sessions and have some supervised practice so you can better assess how well other people are teaching - maybe do some yourself as time permits - but chances are both you and your child will be more successful if you don't overextend yourself.

I hear from a number of parents, including many in developing or underdeveloped countries, who have no consultants or teaching staff - all they have is their child and some Web sites or books that seems to hold the promise of a better future. There is no school, no government assistance, no "free appropriate" education for their child. Those messages are tough to answer. I can't tell anyone not to try teaching, and I can't tell anyone they are guaranteed to do more good than harm in the long run. This is a very technical field. While the basic principles are amazingly simple, putting them into practice effectively and adapting to the very specific needs of an individual child is a complex and demanding job - not an obvious "do it yourself".


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This document is rsaffran.tripod.com/faq.html, updated Sunday, 26-Oct-2014 16:06:03 EDT

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